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Fewer Advanced Alzheimer’s Patients on Feeding Tubes

Practice dropped by half over past 15 years, study reports

By Kathleen Doheny from healthday.com
HealthDay Reporter

TUESDAY, Aug. 16, 2016 (HealthDay News) — The use of feeding tubes for nursing home patients with advanced dementia — a practice increasingly discouraged by some national organizations — is declining, a new study finds.

One Alzheimer’s expert who reviewed the new findings was heartened by the news.

“When we are looking at someone in the advanced stages of a terminal illness, a feeding tube doesn’t make a lot of sense for families,” said Beth Kallmyer, a social worker and the vice president for constituent services at the Alzheimer’s Association.

Between 2000 and 2014, the proportion of residents in U.S. nursing homes with advanced dementia and feeding tubes declined from 12 percent to 6 percent, said study leader Dr. Susan Mitchell. She’s a professor of medicine at Harvard Medical School and a senior scientist at Hebrew Senior Life Institute for Aging Research.

Although the study doesn’t delve into the exact cause of the decline, Mitchell said there are likely a number of reasons.

“The decline roughly parallels the emergence of research, and subsequent expert opinion and recommendations by national organizations, discouraging this practice,” she said.

As research has emerged discouraging the use of feeding tubes in advanced dementia patients, national organizations have developed recommendations that reflect that research. At the same time, doctors also began to more widely accept the idea of palliative care (keeping a person with a terminal illness as comfortable as possible), Mitchell said.

Read the rest at:

https://consumer.healthday.com/cognitive-health-information-26/alzheimer-s-news-20/fewer-advanced-alzheimer-s-patients-on-feeding-tubes-713915.html?utm_source=newsletter&utm_medium=email&utm_campaign=20160818&utm_term=713915

 

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Alzhiemer’s Patients Keep Spark Alive by Sharing Stories

By Jane E. Brody at the New York Times

Can you keep the love shining after your partner’s brain has begun to dim? Just ask Denise Tompkins of Naperville, Ill., married 36 years to John, now 69, who has Alzhiemer’s disease.

The Tompkinses participated in an unusual eight-week storytelling workshop at Northwestern University that is helping to keep the spark of love alive in couples coping with the challenges of encroaching dementia.

Each week participants are given a specific assignment to write a brief story about events in their lives that they then share with others in the group. The program culminates with a moving, often funny, 20-minute written story read alternately by the partners in each couple in the front of an audience.

Read the rest at:

 

 

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Alzheimer’s Disease: Period Pain Drug Cures Symptoms In Mice, New Research Shows

BY  @ International Business Times

The incurable Alzheimer’s disease may now have a cure. A new research by the University of Manchester shows that the most common form of dementia can be fully cured with an anti-inflammatory drug, commonly used for period pain.

Almost 7.5 million new cases of Alzheimer’s — a disease that causes acute problems with memory, thinking ability and behavior — diagnosed around the world every year. In the United States, about five million people currently suffer from the degenerative disease that has claimed one in three senior citizens with some form of dementia.

The team, led by Dr. David Brough, worked with mice to find that a common Non-Steroidal Anti Inflammatory Drug (NSAID) routinely used to relieve menstrual pain — mefenamic acid — completely reversed the inflammation of the brain and lost memory in the specimen.

Mefenamic acid is available as a generic drug and is sold under a variety of brand names.

 

Read the rest, and watch the video at:

http://www.ibtimes.com/alzheimers-disease-period-pain-drug-cures-symptoms-mice-new-research-shows-2401212

 

 

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“How Dementia Works” By Stuffyoushouldknow.com

Hello Chicago Bridge Members,

Below is a podcast from stuffyoushouldknow.com that explains several different dementias in an interesting way. It’s great for those getting into the field to give a brief overview to the various types of dementia and how much it is going to become engrossed into our lives as the population suffering from dementia increases at an astounding rate.

Below is the episode summary, as well as the audio itself. I highly recommend taking a listen during lunch or on your commute.

“The number of people suffering from dementia is expected to explode in the coming decades and, in a pleasant surprise, countries around the world are taking steps to plan for the increase in friendly, caring ways.”

Keep learning!

Neil Kelleher

Chicago Bridge – Leader at Large

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How Much Does Diet Impact Cognitive Health and Behavior?

For quite some time reports have been surfacing linking diet to a variety of physical diseases. It has become commonplace to hear about the rise of digestive problems, food allergies, several types of cancers, heart disease, diabetes and high blood pressure being a result of specific foods or the lack of specific foods in our diet. Increasingly research is linking several additives in food that we eat to many of the physically devastating and in often fatal diseases. Typically there is very little focus or discussion on how these additives affect the brain and behavior.

Current research points out that non-genetic Alzheimer’s may share the common link of other diseases to certain foods and additives. But this time, it’s not the excessive intake of sodium or sugar that is resulting in problems with our physical health.  One blog article calls into question the preservatives found in processed foods and the damaging impact on our brain and our cognitive health. http://tpzoo.wordpress.com/2009/07/01/the-top-12-harmful-food-additives-you-need-to-eliminate-from-your-diet/. This causes me to question how the brain and behavior are affected by other harmful additives in food.

Nitrosamines and Nitrate……Oh my!

There is research suggesting that Alzheimer’s could quite possibly be linked to preservatives traditionally found in processed foods. Preservatives are used to extend shelf life, enhance color, and inhibit the growth of bacteria in food. According to Dr. Suzanne Delaminate, a Neuropathologist at Alpert Medical School, chronic consumption of processed foods containing nitrite preservatives may explain the increased cases of Alzheimer’s. (http://www.doctoroz.com/videos/alzheimers-diabetes-brain?page=3

The Power of Food

Most of us know how powerful food can be. Perhaps we are not accustomed to describing food as powerful, but it is. It provides us with the energy we need to live. What we choose to eat can have a tremendous impact on our current and future health and quality of life.

Food is a huge source of enjoyment with emotional attachments in many cultures including ours. Some people eat to make themselves feel better when they are depressed. Other people eat when they are anxious or bored.

Many of us have experienced the all too common “food coma” or “carb coma.” Whichever term you prefer, this drastic decline of energy has been experienced by the majority of American’s.  The food coma usually tightly grips you right after eating a meal that is high in fats and rich in carbohydrates. The symptoms of a food coma include difficulty concentrating along with feeling tired or extremely sleepy. This is one simple example of the impact that food can have on our brain and behavior and how immediate the impact can be.

Healthier Options

I came across the following quote by Hippocrates: “Let food by thy medicine and medicine be thy food.” I understand and appreciate the advances in medicine and I am very grateful for them. The simplicity of this quote draws my attention because it echoes words that have traveled throughout generations. Many of us have heard from our parents, grandparents or other sources that we should eat a balanced meal three times a day and limit our sodium and sugar intake.

The primary message for maintaining or improving health has been consistent and resembles the recommendations of the Alzheimer’s Association. The Alzheimer’s Association recommends fresh fish, a delicious variety of fresh vegetables, succulent fresh fruits, coffee, chocolate, fresh strawberries….. http://www.alzheimers.net/alzheimers-diet/.  Sound familiar?

Recommendations from the American Cancer Association, the American Diabetes Association and the American Heart Association are basically the same, avoiding foods containing preservative for optimal health.

Preservatives and the type of foods being consumed have traditionally been researched to discover links to diseases of the body, and not the brain. However, the brain receives and uses components from the same foods being consumed. In the not so distant past, the Blood-Brain Barrier was believed to protect the brain from toxic substances. http://www.brainfacts.org/Brain-Basics/Neuroanatomy/Articles/2014/Blood-Brain-Barrier.  Many of us unwittingly consume and expose our bodies to a toxic cocktail of harmful substances daily. What impact are these toxic cocktails having on our brain and behavior? Yet a major focus of discussion remains on the impact certain types of foods and additives have on the body.

So what do you think?

If preservatives found in food are being implicated as one of the potential causes of Alzheimer’s, as professionals in the field of Aging, as Social Workers and Mental Health Professionals should we further investigate the possible damaging effects preservatives and other dangerous additives may have on cognitive health and behavior?

 

Big thanks to Tim Andriano for editing this article.

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Speech-Language Pathologists and Early Stage Alzheimer’s: Strategies to Increase Independence and Quality of Life (Part 2 of 4 series)

My previous blog entry provided an overview of how speech-language pathologists (SLPs) can help those diagnosed with Alzheimer’s.  My next several entries will focus on each stage of the disease while presenting specific strategies that can help individuals increase their independence, communication, and participation in meaningful activities.  This entry will focus on strategies for the early stages of Alzheimer’s.

Early Stages: Receiving the Diagnosis

Alzheimer is a cruel diagnosis. Individuals that have spent their lives engaged in successful careers and raising families can suddenly feel as though they have been stripped of their dignity and decision-making ability when suddenly receiving this diagnosis.  They are forced to quit the work they love, relationships with family members and friends may falter, and others are unsure of how to react to the individual’s diagnosis and their limitations.  Many feel as though they’ve been given a death sentence and have no meaning left in life.  In reality, many individuals in the early stages of Alzheimer’s have years of life left, years that can be productive and meaningful.

The Role of Healthcare Professionals

Healthcare professionals working with this population have a responsibility to constantly identify ways to enrich a patients’ life and to help them use their residual strengths to compensate for weaknesses.  In a society that constantly focuses on planning for the future, individuals suffering from memory loss and their families must be trained to live in the moment and to find happiness in these small moments; this philosophy is especially important since reflecting on recent past events and planning for future events will become increasingly difficult as the disease progresses.  SLPs play an important role in identifying the passions of an individual with Alzheimer’s and in developing and setting goals to help them continue to participate in desired activities more fully and independently.

Common Problems and Strategies to help

Below is a list of common complaints frequently reported by those in the early stages of Alzheimer’s, along with suggestions of concrete strategies that can help an individual to compensate.  Most of these problems are a result of an individual’s short term episodic memory loss.  It is the role of the SLP to identify which strategies may be most helpful for a particular individual and to train them to effectively use these strategies.  Cognitive-linguistic treatment is almost always more effective when provided in the home environment and when another family member or friend is present, to help with the generalization of the strategies.

1. Remembering names and other important information

  • SLPs can help their patients use memory aides, such as a “memory wallet” or organized pictures and notes on a smart phone to help recall information.  They can also establish a home program targeting the recall of personally relevant words, through the use of a strategy called “spaced retrieval training.”
  • SLPs can make visual memory aides to help an individual check their email, use their smart phone, or operate a TV remote.

2. Schedule management

  • SLPs can identify the best strategies for keeping track of upcoming appointments and how to integrate meaningful activities into the patient’s daily routine, such as using a “schedule board.”

3. Managing medications

  • Although SLPs cannot organize medications, they can work with their patients to determine the best system for taking their pills, based on their cognitive abilities (e.g., pill organizer vs. an automatic pill dispenser).

4. Misplacing important items

  • SLPs work with their patients to identify consistent locations for important objects, such as always placing keys and wallet in a basket near the front door.  Visual memory aides on bright paper are often helpful to help individuals remember these locations.

5. Using a computer, cell phone, or TV remote

  • SLPs can make visual memory aides to help an individual check their email, use their smart phone, or operate a TV remote.

6. Participation in volunteer work or other meaningful activities

  • SLPs can work with their patients to determine what short term memory compensatory strategies and memory aides will best help them to navigate to and participate in stimulating activities.

Importance of family support

Strategies to compensate for memory loss with this population must be specific and simple.  Instructing patient to “write things down, make associations, and set reminders” is typically beyond their ability, even in the early stages.  I always remind family members that with Alzheimer’s disease, we can’t expect the individual to change; it is those around them that must make the most changes.  The patient may be able to use written cues, associations or reminders to compensate for memory loss, but they will most likely need consistent assistance from a family member in order to successfully use these strategies.  It is with this support that individuals can learn to better compensate for their memory loss and ultimately increase independence and quality of life.

Thanks to Atika Jilani editing this post and Moodboardphotography for the photo.

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Speech-Language Pathologists and Alzheimer’s disease Part 1 of 4 Series: Overview of our role

The most common question patients ask me, as a Speech-Language Pathologist (SLP) specializing in memory loss and Alzheimer’s, is: “why do I need to see you? I can talk just fine!”  I’ve always felt that one of the most attractive aspects about my field is that we are trained to treat a variety of disorders, both in adults and children. Many are surprised to learn that we have specific therapeutic strategies that can help adults suffering from traumatic brain injury (TBI), stroke, mild cognitive impairment, or a dementia, such as Alzheimer’s disease.

Cognitive Therapy for Alzheimer’s Disease

While an SLP cannot make a diagnosis, they are trained to work with patients suffering from memory loss or other cognitive impairments both to improve lost functions and to teach patients how to compensate for their deficits. As a trained SLP, I recognize that many therapists make the mistake of treating patients with a mild memory loss (resulting from a dementia diagnosis) in the same manner as someone who has suffered from a stroke or TBI. While some cognitive treatment strategies may overlap, a growing body of research is showing that patients with Alzheimer’s and other types of dementia respond positively to specific interventions designed for their diagnosis, such as the use of spaced retrieval, errorless learning strategies, and use of Memory Wallets, Memory Books, and other types of external memoryaides.

What is the Role of SLP?

The most important part of an SLP’s treatment plan, especially when working with Alzheimer’s, is to make sure that communication and cognitive goals are individualized and functional. One of the most rewarding parts about my work is that every patient is unique in how they are reacting to their limitations; we work together as a team to identify what strategies or approaches will best help them. It is important for therapists to first focus on how to maximize the patient’s strengths, rather than attempting to improve their weaknesses. As a patient’s condition progresses, it is the role of the SLP to identify appropriate compensatory strategies and to educate family members and caregivers on what they can do to help their loved one fight this disease.

Major Issues and Challenges for those with Memory Loss

I’ve found that the following three problems are the biggest challenges for the patient and may persist throughout the disease. An SLP’s approach to Alzheimer’s should be holistic, and all treatment goals should take into account these three factors:

  1.  A sense of isolation. Patients may not attend many social gatherings due to their cognitive struggles and because of the unfortunate stigma that still exists in our society towards those with memory loss. Communication may also become more difficult, as they struggle to comprehend or to think of the correct word to say. Meaningful interactions with others are essential to anyone’s quality of life and overall sense of happiness.
  2.  A lack of stimulation or participation in meaningful activities. Patients may feel as though their life is without a purpose, that they can no longer help others or contribute to society. They are no longer working and may not participate in stimulating activities anymore. They may also be unable to initiate meaningful activities as they did in the past.
  3. The loss of dignity. Patients may feel that their independence is slowly slipping away. Some may talk to them in a condescending tone or constantly remind them of their shortfalls. People may talk about them as if they are not present in the room.

We’ll be discussing specific interventions and strategies for the early, middle and late stages of Alzheimer’s in upcoming entries.

 

Thanks to Atika Jilani for editing this post. Thank you to Larah McElroy for the photo.

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Dancing Through Dementia: Benefits of Dance/Movement Therapy

In regard to individuals with dementia, dance/movement therapy provides not only physical, but psychosocial benefits as well. In fact, it is the psychosocial aspect that frequently becomes the top priority, especially when working with an illness as complicated as dementia. Too often we see individuals become isolated due to the effects of the dementia.

Common Symtoms and the Dance/Movement Therapy Solution

Difficulty with communication, changes in personality, and challenging behaviors are just a few effects that may cause an individual with dementia to withdraw socially, shut down emotionally, and become isolated. Friends, family, and professionals often have a hard time coping with these changes as well and may unknowingly and inadvertently contribute to an individual’s isolation. So, what can be done? Enter dance/movement therapy.

Dance/movement therapy has the ability to connect an individual to the world around them in ways that traditional forms of therapy cannot. Through the use of rhythm, sound, and movement, individuals begin to reconnect in ways previously unimaginable.

Psychosocial Benefits of Dance/Movement Therapy

• Increase self-awareness
• Encourage social interaction
• Manage and/or reduce symptoms of depression and anxiety
• Channel agitation and aggression into healthy modes of expression
• Provide opportunities for safe and dignified expression
• Create alternative approaches to communication
• Maintain and, at times, improve memory and cognitive functioning
• Strengthen neurological pathways

These are only a few examples of the benefits of dance/movement therapy. Of course, there are always physical benefits of movement. For more information on how these benefits are attained please read my previous blog post Dancing through Dementia: Basic Techniques and for more general information on dance/movement therapy please read Dancing through Dementia: What is Dance/Movement Therapy?

Which form of therapy works best?

It is important to note that dance/movement therapy won’t be everything to everyone. Certain people respond to certain forms of therapy and that is why it is important to consider different methods and techniques when working with individuals with dementia. Dance/movement therapy is not the only form of alternative and creative arts therapies
that can provide stimulation and meaningful engagement to individuals with dementia. For more information on these alternative therapies please read fellow Chicago Bridge writer Christy Shoenwald’s blog article about Art therapy. Also check out the America Music Therapy Association and National Association for Drama Therapy.

This is the third installment of the six-part series, Dancing Through Dementia. To read more about dance/movement therapy please stay tuned for clinical examples and case studies.

 

Thank you to Kristen Pavle for editing this article and thank you to jvandoor for the use the photo.

 

Honoring the Individual: The Value of Person-Centered Care in Aging

On March 21, 2012, Courtney Bouker from Arden Courts of Northbrook presented Culture Change: The Person-Centered Dementia Care Approach. This Chicago Bridge event was hosted by Northwestern University Cognitve Neurology and Alzheimer’s Disease Center (CNADC) and food was provided by Warren Barr Pavillion.

The Approach

For many seniors examining their long-term care options, the decision to “age in place” remains the most desirable. Unfortunately, for those individuals with dementia who require a higher level of care, often nursing homes are the only option. For many, the traditional model of institutionalized care represents a detention center they will try desperately to avoid. The culture change model represents a more person-centered approach in which the comforts of aging in place can be replicated in an institutional setting.

Also referred to as person-centered care, culture change values the needs and desires of the individual, thereby empowering seniors to exercise choice and preserve a sense of autonomy in a nursing home setting.

Applications for Culture Change in Dementia Care

As an advocate for culture change and the model of person-centered care, Bouker shared her career journey through various Continuing Care Retirement Communities (CCRCs), providing examples of how this approach could be applied. As an experienced care provider for individuals living with dementia, Bouker helped attendees explore the approaches to activities of daily living that could mean the difference between an environment of institutional care and one reminiscent of home. Attendees shared their personal preferences for daily activities such as meal times, sleeping schedules and hobbies to demonstrate that the “one size fits all” approach to institutional care does not address individual needs and can lead to difficult behaviors. Culture change considerations for nursing home residents may include:

Daily        Activity Culture Change Model
Meals         Provide residents with choice, and honor meal habits and preferences
Bathing      Make residents comfortable, respect their privacy. Give residents choice of bath times, provide warm towels.
Sleep         Residents choose when to wake/sleep

Approach to Difficult Behaviors

According to Bouker, triggers for behaviors could include physical, emotional, environmental or task-related changes. In the culture change model, residents’ needs, habits and routines are taken into account to limit the number of behavioral triggers and foster a safe and comfortable environment. When implementing person-centered care, it is important to get to know the individual, honor what makes the person human and apply the golden rule. For example, if you were woken up every morning at 6:00am only to wait in the dining room for two hours before the start of breakfast, you would likely become agitated!

Benefits for Aging Network

Under traditional institutional care models, nursing home staff are bound by the structure, order and designated outputs of the living community. The culture change model encourages staff to engage with residents one-on-one, thereby fostering closer relationships and increasing employee satisfaction. Higher employee satisfaction may ultimately lead to less workplace turnover.

The Language of Culture Change

The most basic component of culture change is a transformation of the words and phrases used in a nursing home atmosphere. Below is a sample of traditional vocabulary used and the same phrase modified for a more person-centered emphasis.

Common                                                          Phrase Culture Change Model
Bib                                                                          Napkin, apron
Diaper                                                                    Underwear
“I am going to take Fred for a walk”                         Fred and I are going for a walk
*Examples provided by Courtney Bouker

Want to Learn More or Get Involved?

Please visit the Pioneer Network site to learn more about educational events, the Regional Pioneer Coalition, and the Pioneer Annual Conference. Related websites include:

Thanks to Elsye Baylis for editing this post.

Antipsychotics and Dementia: Do they mix?

Recently I met with a wife who felt she could not longer safely care for her husband because his dementia condition made him increasingly aggressive. Under our care in a memory unit, the gentleman exhibited similar agitation and combativeness and was assigned two of our best certified nursing assistants (CNAs), both male and both over six feet tall. I wondered how this man’s wife, petite and just shy of five feet, had managed to be a caregiver for as long as she had. After a couple days with us, someone suggested an evaluation with the psychiatrist in the hopes of reducing the resident’s outbursts and anxiety. His wife was skeptical, explaining that he had received similar medication therapy once before with very negative results. Clearly, the incident had impacted the wife greatly.

Dementia-Related Behaviors

For anyone who has worked directly with people living with a dementia diagnosis, you are probably familiar with the oftentimes unpredictable behavioral changes associated with the illness. Behavioral changes, such as increased agitation and aggression that manifest in verbal or physical abuse, may present for no apparent reason or without provocation but are a part of the neurological disease process. Often, the behaviors serve as a means of communicating discomfort or unmet needs. Regardless of their origin, these behaviors are upsetting for both the individual living with the disease, as well as caregivers and family members who may regularly encounter these difficult situations.

Non-pharmacological Interventions

Non-pharmacologic interventions should always be promoted as the first line of action in reducing dementia-related behaviors. Such interventions are not only emphasized by social service providers, but also by medical organizations such as the American Association for Geriatric Psychiatry, the American Psychiatric Association and the American Society for Neuropsychopharmacology. Non-pharmacologic interventions include various types of sensory therapy, such as those Christy Schoenwald wrote about in her recent blog article on engaging the senses in dementia care. Another example of a non-pharmacological intervention is dance therapy for persons with living with a form of dementia which can be used an alternative method of communication.

There are instances, however, when people living with dementia may concurrently benefit from alternative approaches, such as pharmacologic interventions, in which antipsychotic medications are prescribed to alleviate behavioral symptoms.

What are Antipsychotic Medications?

Traditionally, antipsychotics are used to treat psychosis or mood disorders such as schizophrenia or bipolar disorder. However, some studies have found these drugs to be helpful in managing potentially harmful behaviors in older adults with dementia. The prescribing of antipsychotics for dementia-related behaviors is a practice known as “off-label” use. Over the past decade, various studies have been produced mixed results in determining the efficacy of such treatments. In addition, different types of antipsychotics have produced different risks,  as illustrated in a recent article published in the British Journal of Medicine (BMJ).

Are They Harmful?

There are documented adverse effects for older adults taking antipsychotics, which can be attributed to increased frequency of use and slower metabolic rates in this population. Some of the most common side effects include increased risk of falls, delirium, and oversedation. As written in the article “Illegal Use of Chemical Restraints in Illinois Nursing Homes,” many nursing home misuse antipsychotic to control and “restrain” resident’s with behavioral disturbances.  Most importantly, the off-label use of antipsychotics in people living with a form of dementia has been linked to increase mortality at a rate of 1.7 times that of normal mortality rates.

Black Box Warning

As a result of the increased mortality rates, the Food and Drug Administration (FDA) administered a black box warning – the strongest warning issued by the FDA – on all antipsychotics in 2008, highlighting this increased risk of mortality in older adult patients. Utilization rates of antipsychotics in people living with a form of dementia have been declining over the past decade, most likely in response to federal oversight. According to the guidelines dictated by the Centers for Medicare and Medicaid (CMS), nursing home residents on antipsychotics must receive gradual reductions in doses, as well as behavioral interventions to compliment pharmacologic interventions.

Weighing In: Risks and Benefits

Defenders of antipsychotics claim that pharmacologic interventions are sometimes necessary and beneficial to a person suffering from constant agitation or who poses an immediate threat to himself or others. Additionally, not all antipsychotics are created equal,and some carry more risks than others. With an increase in knowledge and education, practitioners are learning how to best administer these drugs in a unique population. Continuous monitoring for side effects, low dosing, and short timeframe of use are all contributing to more prominent best practice guidelines.

What do YOU Think?

I’d love to hear your thoughts on this subject, and what experiences or encounters you have had that stand out for you. Is there room for compromise?

**This article was edited by Jaimie Robinson. The picture was taken by michaelll on flikr.com